Orthopaedic

appliances
 Types of forces
Orthodontic force
 Applied to the teeth by means of wires and
other active components of removable or fixed
appliances
 Light forces are produced
 Ranges between 50-100 gms
Orthopaedic force
 They are heavier forces that brings about
changes in the magnitude and direction of bone
growth
 Ranges about 300-500 gms
 Appliances such as orthopaedic appliances
 Introduction
 The appliance that produces skeletal changes by
applying orthopaedic forces are orthopaedic
appliances
 Basis of orthopaedic appliances
 Usually uses teeth as “handles” to transmit forces to the underlying skeletal structures
 Heavy forces of over 400 gms totally compresses the PDL on pressure side and causes
hyalinization that prevents tooth movement .
 These heavy forces are conducted to the skeletal structures to bring about skeletal changes .
 Intermittent forces ranging from 12 – 14 hours a day are believed to bring about minimum tooth
movement but maximum skeletal changes .
 Types of orthopaedic appliance
 Headgears
 Face mask or reverse headgears
 Chincup
 Headgears
 Most commonly used
 J.S gunnell invented occipital anchorage
(first form of headgear) later Edward
Hartley angle developed appliances to
correct different types of malocclusions
 Used during growth period to intercept or
correct certain malocclusion and to distalize
the maxillary dentition and maxilla itself
 Components of headgears
 The face bow - inner-outer type
- j hook type

The force element The force element is that part of

assembly which provides the force to bring about
the desired effect . Usually comprises of springs ,
elastics and other materials
Connects the face bow to the head strap or neck
strap .
 Head cap or cervical strap
 This appliance takes anchorage from rigid bones of the skull or the back of the neck by means
of head cap and cervical strap or combination of both
 Principles in the use of headgears
1. CENTRE OF RESISTANCE OF DENTITION
–
 the inner bow of the face bow is generally
attached to maxillary first permanent molars
through buccal tubes on these teeth . Thus the
force acting on the molars tends to displace
them .
 Centre of resistance for a molar is usually at the
mid root region slightly apical to furcation .
 CENTRE OF RESISTANCE OF
MAXILLA
 Centre of resistance for a molar is
usually at the mid root region slightly
apical to furcation
 Centre of resistance of maxilla should be
considered as a whole when planning for
headgear . It is believed to exist at
posterosuperior aspect of zygomatic-
omaxillary suture .
 forces passing through the centre of
resistance of maxilla produce translation
of the maxilla in distal direction .
 Forces passing below or above causes
rotation of the maxilla .
 THE POINT OF ORIGIN OF FORCE
ANCHORAGE FROM OCCIPITAL REGION  ANCHORAGE FROM CERVICAL
REGION
Produce a superior and distal force on the teeth
and maxilla  Produces inferior and distal force on the
maxilla and teeh
 THE POINT OF ATTACHMENT OF FORCE
 It refers to the hook present on the
distal end of the outer bow to which the
force element is attached .
 By altering the point of attachment it is
possible to alter the direction of force
 It can be done by varying length and
angulation between the outer and inner
bow
Types of headgears
Combination pull headgear
Assymetrical headgear
 Uses of headgear
 Orthopaedic effect – used to restrict downward and forward growth of maxilla
 Anchorage augmentation – extraoral forces are used to reinforce anchorage when those of
intraoral are insufficient . It should be worn for 10 hrs / day and force value should be of 300
gms / side .
 Distalization of molars –
 Molar rotation
 Space maintenance
 Face mask
Headgears are usually used for the purpose of reinforcement of anchorage and for maxillary
distalization . However when an anterior protractory force is required protraction head gear is
used.
The principle of pulling force on the maxillary structures with the reciprocal pushing force on the
forehead and the mandible through facial anchorage is sound enough to be used as a therapeutic
procedure for treatment of prognathic syndromes , maxillary retrusions , clefts and mandibular
prognathism
Hickman (1972) claimed he was the first to us facemask but this modality was made popular by
delaire around the same time .
Its components consists of a rigid framework which takes anchorage from from chin or forhead
Parts of facemask
 Indications

 Used in growing patients having prognathic mandible and retrusive maxilla

Selective rearrangement of palatal shelves in cleft patients
Correction of post surgical relapse after osteotomies
Used to treat certain accessory problems associated with nose morphology such as lateral deviation
Bending the condylar necks for stimulating TMJ adaptations in posterior displacement of chin
 Sites of anchorage – from chin
from skull
From chin and forehead
 Parts of reverse pull headgear - chin cup
elastics
Forehead cap ,
intra oral appliances ,
metal frame
 Types
Protraction type Delaire type
 Types
Tubinger petit
 Biomechanical considerations
 Amount of force – 1 pound or 450gms per side to bring about skeletal changes
 Direction of force – most authors recommend a 15 – 30 degrees of downward pull to the
occlusal plane to produce forward and translatory motion of maxilla
 Duration of force – low forces (250gms) takes 13 months to produce desired effects .
high forces (1600 – 3000 gms ) takes 4 – 21 days .
Frequency of use - 12 – 14hrs
 Chincup
 It is referred to as an extraoral orthopaedic device that covers the chin and is connected to the
headgear
 Used to restrict the forward and downward growth of mandible
 Consists – a headcap , an adjustable elastic strap , an force element - that connects the chin cup
to headcap
 Used for treating class 3 malocclusion
 Fabrication – can be individually fabricated or prefabricated commercially available
 Force of magnitude –150-300 gms preside at the time of delivery .over the next 2 months the
force is gradually increased to 450- 700gms per side . 12- 14 hrs .
Types of chincup